A Middle-Aged Woman With New Onset Hypertriglyceridemia

A 58-year-old woman with hypertension was referred to our cardiology lipid clinic, as she had new onset of hypertriglyceridemia. She has a past medical history of asthma and GERD but there is no known history of diabetes mellitus, dyslipidemia, or a familial history of known lipid disorders. She is very active, exercises regularly and drinks 1-2 glasses of wine with meals several times each week.

Patient's medications include Esomeprazole 40mg, Montelukast 10mg once daily, Lisinopril 20mg daily, and Metoprolol succinate 50mg daily for treatment of hypertension.

On exam, her blood pressure is 142/90, pulse 74, weight 128 pounds, height 5 foot 3 inches and BMI 22.7.

Physical exam was unremarkable and without stigmata of hyperlipidemia.

Her fasting glucose is 102, A1c 5.3, total cholesterol 257, triglycerides 734, HDL 45 and calculated LDL 65. A repeated lipid panel that was known to be conducted in the fasting state confirmed very high triglycerides.

A triglyceride level obtained several years earlier was 169.

In addition to recommending alcohol cessation, what is the most appropriate next step in the management of this patient?

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